Ivan Castro in September 2006 in Youssifiyah, Iraq, minutes before a mortar round exploded near him and left him blind.

BRAIN INJURIES ALSO DANGER TO VISION

Glenn Minney lost most of his sight from a combat explosion. But it wasn't just the injuries to his eyes that cost him his vision it also was damage to his brain.

Minney, then a Navy corpsman, was wounded when a mortar landed near him in Haditha, Iraq, in 2005. The blast threw him 30 feet. His back struck a metal railing, whipping his head backward. He lost his right eye. Vision in his left eye is impaired from physical injury and brain damage, he says.

An emerging threat from the fighting in Iraq and Afghanistan is damage to the brain that affects vision, Pentagon and Department of Veterans Affairs medical researchers say. This type of injury could mean that there are thousands of veterans with undiagnosed vision problems, says Tom Zampieri, of the Blinded Veterans Association.

Doctors didn't find Minney's neurological damage until after he left the military and was screened for brain injuries by the VA. "The public doesn't know the true extent of these (brain) injuries," says Minney, 40, married and the father of two. He's now a patient advocate for the VA in Frankfort, Ohio.

Concerns about eye injuries have prompted federal legislation that would create a $5 million Pentagon-based center for research and treatment of injured eyes. It also would create a registry to track eye wounds.

Minney suffered severe vision loss. Researchers are finding that less-severe vision problems also can occur among troops who suffer minor brain concussions from combat, particularly exposure to a blast. "There are a lot of patients who have suffered mild to moderate brain injuries. Upon initial examination their eyes looked healthy, but they were still reporting problems with their vision," says R. Cameron VanRoekel, an Army optometrist at Walter Reed Army Medical Center in Washington.

Gregory Goodrich, a research psychologist at VA facilities in Palo Alto, Calif., had similar findings in a study of 101 Iraq and Afghanistan war veterans with mild traumatic brain injuries. Many are still in the service.

Goodrich found that 40% to 45% of the patients suffered vision loss even though their eyes were physically healthy. The biggest problem was an inability for both eyes to operate precisely together. This can lead to eye strain and blurred vision.

Left undiagnosed, it can also hamper vocational or educational training and aggravate depression and post-traumatic-stress disorder, Goodrich says. Veterans may need an eye care specialist and corrective eyewear, he says.

But Goodrich fears that routine eye examinations may not uncover the problems. "In many cases, we're seeing active-duty troops, and they want to get back and join their units," he says. "So they don't want to hear that there's something they need to go get treated for."

ARLINGTON, Va.  Two days before a 10-mile race here, Army 1st Lt. Ivan Castro is explaining how he will run tethered to another soldier — one who can see.

As he speaks, his wife lovingly extends her right hand to Castro's face, fingers outstretched. But Evelyn Galvis pauses inches away.

"I used to be able to reach out and touch him, caress him, without telling him first, 'I'm going to touch your face,' " she says. Now, "if I just reach out and touch him, he'll startle."

Castro, 40, a paratrooper with the 82nd Airborne Division, is one of more than 1,100 veterans of Iraq and Afghanistan — 13% of all seriously wounded casualties — to undergo surgery for damaged eyes. That is the highest percentage for eye wounds in any major conflict dating to World War I, according to research published in the Survey of Ophthalmology.

It's a reflection of how eye injuries have become one of the most devastating consequences of a war in which roadside bombs, mortars and grenades are the most commonly used weapons against U.S. troops. Brain injuries and amputations have long been the focus of the damage such weapons are inflicting, but the Army has acknowledged in recent weeks that serious eye wounds have accumulated at almost twice the rate as wounds requiring amputations.

Body armor that protects vital organs and the skull is saving lives. But troops' eyes and limbs remain particularly vulnerable to the blizzard of shrapnel from such explosions.

Each explosion unleashes large metal shards and thousands of fragments, says Army Col. Robert Mazzoli, an ophthalmological consultant to the Army surgeon general. "Those small missiles are generally innocuous if they hit the (protected) forehead, face (or) chest but are devastating when they hit the eye," he says.

Surgical facilities are kept close to the fighting, so troops can be treated in minutes. Partial or total vision has been restored in most cases involving eye injuries, military statistics show. But hundreds of troops have been left with impaired vision, and dozens have been blinded.

Troops in Iraq routinely wear protective eyewear, but it doesn't always work. When a roadside bomb in Baghdad blew a hole through the heavily armored vehicle carrying Army Sgt. Luis Martinez last April, the force from the blast stripped off his helmet, headset and goggles. After the dust settled, Martinez, 38, could see nothing out of his left eye and only streaks of blood in his right. He waited for help, terrified about the damage to his eyes.

"That was the first thing I asked" hospital personnel, the National Guard soldier recalls. " 'Am I going to be blind?' "

Surgeons later restored vision to his right eye, although bits of glass are embedded there. He remains blind in his left.

"At least God was kind enough to protect me, to keep my right eye and see my family," says Martinez, of Vega Alta, Puerto Rico, who is married and the father of three.

Formidable challenges await troops who return home blind or with serious eye injuries. In the most severe cases, they will struggle to cope emotionally and financially.

About 70% of all sensory perception is through vision, says R. Cameron VanRoekel, an Army major and staff optometrist at Walter Reed Army Medical Center in Washington. As a result, the families of visually impaired soldiers wrestle with a contradiction: The wounded often have hard-driving personalities that have helped them succeed in the military. Now dependent on others, they find it difficult to accept help.

Because the Pentagon has no rehabilitation services for the blind, the path to recovery often leads directly to the Department of Veterans Affairs. The VA operates 10 centers across the country for blind rehabilitation that teach visually impaired veterans how to function in society. The centers have 241 beds, and it takes an average of nearly three months to get in. Iraq and Afghanistan casualties go to the front of the line, says Stan Poel, VA director of rehabilitation services for the blind. So far, 53 have enrolled in the blind rehabilitation programs, the VA says.

The department plans to open three more centers beginning in 2010, Poel says.

'He has no light in his life'

Even now, more than a year after her husband's return from Iraq, Connie Acosta is taken aback to find her home dark after sunset, the lights off as if no one is there.

Then she finds him — sitting in a recliner in their Santa Fe Springs, Calif., house, listening to classic rock. Sgt. Maj. Jesse Acosta was blinded in a mortar attack 22 months ago. He doesn't need the lights.

That realization often makes Connie cry. "You kind of never get used to the fact that he really can't see," she says. "He has no light in his life at all."

The tiny piece of shrapnel that blinded Acosta, 50, an Army reservist, father of four and grandfather of three, was precise in its destruction.

On the morning of Jan. 16 last year, Acosta led soldiers on a 3-mile fitness run across Camp Anaconda in Balad, Iraq. Suddenly, insurgents attacked the camp with mortars.

Acosta remembers that he stopped, turned to yell at his soldiers and then dived for cover.

"Bam! That was it," he recalls. "Lights out."

An explosion about 60 feet away sent a piece of shrapnel — perhaps three-quarters of an inch long — through his left eye. It struck his brain and came out his right eye.

"It was a perfect hit," Acosta says.

Rushed to the Air Force Hospital at Anaconda, he spent seven hours in surgery. Army Maj. Raymond Cho, an ophthalmologist, removed Acosta's right eye and carefully reassembled his left one.

"I didn't want him waking up missing both eyes and wondering for the rest of his life, 'Gosh, could they have saved at least one?' " Cho says. "So he knows that we did everything we could."

Acosta regained consciousness as he was being returned to the USA. In Germany, a doctor told him that his right eye was gone and his left eye, although stitched together, likely would never see light.

"He said, 'You're going to have to start a whole new life from here on,' " Acosta recalls.

"I go, 'So I won't be able to see my kids? My grandkids? Nobody? I won't be able to see blue skies?'

"He said, 'Nope.'

"I just sat there. What could I do?

"A lot of things went through my mind," Acosta says. "Am I going to be accepted this way? Am I going to be rejected? I was pretty independent all my life, and I did everything. So it was pretty tough."

VA plans more clinics

Pentagon doctors can rebuild eyes, reconstruct eye sockets and nurse casualties back to health, but soldiers with serious vision problems who want to learn how to adapt into civilian life must rely on VA centers that also serve the elderly and other veterans.

The VA plans to invest $40 million this fiscal year to create 55 outpatient clinics across the nation, providing rehabilitation for veterans learning to cope with partial vision, says James Orcutt, the VA's director for ophthalmology.

The department also is taking part in two clinical trials focusing on artificial vision, says Ronald Schuchard, director of the Atlanta VA rehabilitation research and development center. The trials involve implanting silicon chips in eyes. The chips act as receptors that can transform light into electrical signals that can be transmitted to the brain. It is cutting-edge research, Schuchard says.

However, Orcutt says, "I think we're a long way from a practical use of some of these."

At the VA's rehab centers for the blind, specialists teach orientation and mobility skills. Visually impaired veterans learn to use a white cane, public transportation and perform daily routines. They also are offered computer instruction and the use of special scanners for reading text. They are assessed and treated, if necessary, for psychological readjustment to their sight loss.

The VA does not provide guide dogs, but it helps link veterans with guide-dog schools that commonly provide a dog and training virtually free to veterans, Poel says.

Iraq veterans sometimes find the VA blind rehab programs, which cater largely to elderly veterans, to be a poor fit for a younger generation. Army 1st Lt. Castro says he felt somewhat out of place during rehab at a VA facility in Augusta, Ga.

After the Army sent Jesse Acosta to a VA center for the blind in Palo Alto, Calif., for rehabilitation in January 2006, he and his wife became unhappy with the facility, describing it as having a "nursing home" atmosphere. It is a five-hour drive from his home.

"It did not fit my needs," Acosta says.

He left the VA after a few months and was accepted, free of charge, into the Junior Blind of America rehab program near his home in Santa Fe Springs. Last month, he completed training with his new guide dog at The Seeing Eye school in Morristown, N.J., and now has Charlie, a German shepherd.

All that is left, Acosta says, is figuring out the rest of his life.

He has fought a medical discharge from the Army until his medical care is complete. Ultimately, he will earn disability income for his wounds. Acosta was an energy technician with Southern California Gas before he was called to active duty.

He is still with the company, though unpaid, and a different job awaits him — one tailored to his disability, Connie Acosta says. It's unclear whether Jesse will want it, she says.

"We're hoping for the best," she says. "He's the type that constantly has to be kept busy. We always have an agenda. I have a calendar going constantly with things happening."

It begins when they wake, and he wants to know the weather and the color of the sky, she says. Nothing in the house can be moved; he's memorized the location of every chair and table.

He has his routines and chores, including weightlifting in the backyard or fiddling with the fuel pump on the 1969 Dodge Dart. (He fixed it.) Daughter Brittany, 14, is mustered into duty to operate the computer for her father until she pleads for a break.

"Taking care of Jesse has been an experience," Connie Acosta says. "He's a sergeant major in the Army, and they're tough people. He's a tough person to live with and then, worse, being blind.

"Sometimes, he can be demanding. And I deal with it. I'm used to making sure that everything's in line. That he's got everything. And that's basically all I've got to do."

'I want to feel productive'

Castro thought he knew how his life would play out.

A former Army Ranger who had worked his way out of the enlisted ranks to earn an officer's commission, Castro commanded a scout reconnaissance platoon and dreamed of becoming a Special Forces team leader.

Instead, the last thing he would ever see was the colorless expanse of an Iraqi roof in Youssifiyah, Iraq.

A mortar round landed a few feet away from him there on Sept. 2, 2006. The blast killed two other soldiers from the 82nd Airborne Division and sent shrapnel tearing into Castro's left side. The explosion damaged a shoulder, broke an arm, fractured facial bones and collapsed his lungs. Doctors amputated part of a finger.

The blast also drove the frame of his protective eyewear into his face. When Castro regained consciousness days later at the National Naval Medical Center in Bethesda, Md., his wife, Evelyn, sat at his bedside. She told him his right eye was gone, but doctors hoped to salvage vision in his left.

The surgeons later removed one last piece of shrapnel from that eye. When they took off his bandages and flashed a light for Castro to see, he thought the eye was still covered. "That's when he told me, 'Ivan, you're not going to be able to see again,' " Castro recalls. "I swore (it was like) I was standing between the World Trade Center and the two towers had just come down on my shoulders."

From that moment on, through convalescence and rehabilitation, Castro would struggle to regain a measure of independence.

Castro has become an advocate of rehabilitation funding for the blind, visiting members of Congress. After the 10-mile race in October, he ran the Marine Corps Marathon three weeks later, finishing in 4 hours and 14 minutes.

He concedes that he needs his wife's help. Evelyn Galvis gave up her career as a bilingual speech pathologist in Fayetteville, N.C., to help her husband. She supervises his medical care and drives him around.

She guides him through crowds, keeping him aware of raised edges in the walkway and steps. She reads his menu in restaurants and tells him where the food sits on the table. She watches him memorize his hotel room, starting from the doorway and circling within the four walls to keep account of beds, the tables, the wastebasket, the bathroom.

"My husband used to be a very independent individual," she says.

Castro hopes to stay in the military.

The Army has let several amputees stay in the ranks as well as one blind captain, who will be an instructor at West Point Military Academy after completing post-graduate education. Castro awaits word on his future; the Pentagon won't comment on his situation.

"There's a world in front of me I can't predict or envision because I haven't been there yet. I haven't lived this yet. I haven't lived blind," he says. "All I ask is to stay in the Army and finish out my years … I want to feel productive."

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Army Lt. Ivan Castro, who was blinded by shrapnel in Iraq, gets a haircut from barber. More than 1,100 troops have suffered serious eye injuries during the war.

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